Provider Demographics
NPI:1043478126
Name:TERRIO, TIMOTHY JON (PT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JON
Last Name:TERRIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CALLOWAY DR STE 603
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2514
Mailing Address - Country:US
Mailing Address - Phone:661-873-7975
Mailing Address - Fax:661-616-9199
Practice Address - Street 1:11206 OLIVE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-5846
Practice Address - Country:US
Practice Address - Phone:661-377-1700
Practice Address - Fax:661-616-9199
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA133052274OtherBLUE CROSS OF CA
CA193518600OtherUS DEPT OF LABOR
CAZZZ008062OtherBLUE SHIELD
CA193518600OtherUS DEPT OF LABOR
CADE5473OtherRAILROAD MEDICARE
CADA4626OtherRAILROAD MEDICARE
CAZZZ008062OtherBLUE SHIELD